Prostate cancer treatment

Hi PCT , sorry to hear that your OH has prostate cancer but you have come to the right site for help.

Firstly, there is no right or wrong about choosing and it is very personal to you.  There are side effects from all treatments and what might be ok for a 75 year old may not be good for a 45 year old with an active sex life.  I would just like to say that both surgery AND RT are given with a curative intent, so it isn’t correct to say that RT doesn’t get rid of it.  I am sure you will get lots of great advice from others.  Feel free to ask any questions.  David

From what my own doctor told me when my wife and myself wanted his advise on treatments , without hesitation he pointed me towards having radiotherapy treatment,  advised against surgery as its not guaranteed to completely remove all the cancer affected area, where as radiotherapy completely destroys the cancer cells. Think you have been miss informed 

Hello PCT 

A warm welcome to our "exclusive club", although I am so sorry to find you here. To give you the best advice we would need a history of his PSA tests and his Gleason Score and TNM staging from the prostate biopsy.

If you have been given the 3 options then the two interventions will be with a view to a "Curative Pathway". I suggest you list the "pros and cons" of each treatment as to how they would affect you and your family. Do your research from trusted sources, Cancer Research UK, Prostate Cancer UK and Macmillan (not Dr Google). To start you off here are two links:

Surgery for Prostate Cancer

Radiotherapy for Prostate Cancer

Feel free to ask any questions, however trivial - you will get honest answers from people who have been there.

Best wishes - Brian.

Hi,

I can only put forward my personal experience for the surgery route.

We chose surgery as it seemed for us to be the neatest and most straight forward option. No long term hormone therapy or multiple radio therapy sessions. Both types of treatment have their pros and cons and unfortunately both have their collection of positive and horror stories online. Definitely this is the best place for supportive, truthful and realistic conversations (unlike Facebook groups etc.)

I can definitely say (6 weeks after the operation and 4 1/2 weeks after catheter removal) that I am very, very happy with our decision. I feel fit and healthy, the incisions are healing perfectly, and I had minimal pain after the surgery. The wee situation is positive and getting better each day (precautionary small pad at night that has been completely dry pretty much since day 1, and a single pad during the day to catch the couple of minor leaks when I’m not concentrating - lifting bags into the car while twisting and not thinking about pelvic floor, for example). Again there are many different stories out there, but my personal experience has been extremely positive. 

ED is another matter. I have not lost any sex drive and still look at my missus with  eyes. And the feeling down there is definitely still active. However, I only had nerve sparing one side and apart from a couple of noticeable times when there has been some movement, things are not happening yet (I have been told it could be months or even a year or two to get spontaneous reactions back again). So other options are to be investigated (got lots of information leaflets from the hospital!)

Main advice is to have in depth and open discussions with both surgery and radio therapy doctors and take a notepad to record the mass of details they will throw at you, then take time together to go through all the pros and cons and work out which combination fits best for your life. We sat for ages going through all the details and came to a decision together that we are both very happy about.

Good luck and wishing you both all the best! And hope your path is as positive as ours!

I’m wondering if the words “radiotherapy doesn't completely get rid of it only slows it down and shrinks it” are referring to the initial hormone therapy? If I had gone the RT route, there would have been 3 months hormone therapy exactly to do that and shrink things before attacking it with radiation. 

Hello PCT

My O/H decided on Prostatectomy as felt he wanted the cancer removed due to family history of PC

Originally diagnosed as T2b however histology after RP came back as TCb as had spread to one seminal vesicle so then required follow up with RT/HT as an insurance incase some cancer remained.

He made the choice of RP also due to fear that if he had radiotherapy instead it would be very difficult if not impossible to then have a Prostatectomy due to changes made to the prostate by radiation, also prostate was 100cc in volume so would have required some treatment to reduce its size before any treatment. 

He did recover well with regards to continence partly due perhaps to doing pelvic floor excercises before and after surgery but suffered ED.RT caused him to go backwards on this with urgency and frequency although he still doesn't require pads 1 year on from RP.

One thing we wasn't aware of was the removal of bladder splinter during surgery hence pelvic floor excercises are important to help strengthen bladder control.He also elected to have nerve sparing surgery although part of one was unhealthy (not cancerous) so that section was removed.His latest PSA is <0.01 so hopefully that will continue with 3 monthly PSA tests.

He was not able to have surgery for around 4 months from decision making in Jan 2024 due to needing to lose weight for surgery don't  and will never know if this had any bearing on its spread to SV and disappointed that he had to undergo RT/HT in the end aswell.

Think both treatments can cause incontinence & ED, HT effects libido.

Feeling is no one case is the same there are so many different aspects to consider.

Hope this has been helpful we know how scary and worrying it is to make a choice in treatment.

Hi PCT,

Sorry to find you here, but you will find lots of great advice from a friendly bunch of people who are all (or have been) in the same boat you now find yourself in.

It will help if you can let us know the history of his PSA tests and  Gleason Score plus TNM staging from the prostate biopsy. In the meantime I can echo the advice from Millibob about researching all 3 options & making a list of pro's & cons for each one before you make a decision based on what is important to you. 

I personally chose the HT / RT route as a curative option when I was diagnosed in 2023 as Gleason 7 (4+ 3) & if it helps at all you can read my journey by clicking on my profile picture.

Best Wishes

Brian

Sorry that's T3b not Tcb

Hi PCT

That's Def incorrect,  Radiotherapy as good as surgery and in some cases can be better particularly if aggressive and near the capsule edge

Potentially surgery can come with ED which obviously can be traumatic although I have to say not everyone has that issue.

Only downside to RT is , if cancer returns surgery very difficult after but not the other way round, RT after surgery.

If u can give some stats that can help with getting the best advice IE, PSA Gleeson, what does MRI say or staging.

Best wishes 

Steve 

Hi PCT.. In addition to others responses,  It’s not my understanding that radiotherapy does not get rid of it.  My prostate has just been hit with 59 pieces of radiation inserted right inside my prostate, if any cells whether cancerous or not survive that then what was the point and why are so many people having RT..  All of us when diagnosed with prostate cancer want to get rid of it, however, not at any cost, which is why we look at options which may or may not be available to us, and do research and question the MDT team, so we can make our own informed decision,     Was it a surgeon who said that to you, ie the same one who is offering active surveillance ?    This forum gives people our experiences of the different options and how we got to our decisions and our outcomes….